Transobturator tape surgery experience: urodynamic evaluation of 220 patients in a single tertiary center in Turkey

Hasan Ali Inal; Zeynep Ozturk  Inal

doi:10.2298/VSP201122025I

Hasan Ali Inal Konya Education and Research Hospital, Department of Urogynecology, Konya, Turkey
Zeynep Ozturk Inal Konya Education and Research Hospital, Department of Urogynecology, Konya, Turkey

DOI: https://doi.org/10.2298/VSP201122025I

Keywords: female, suburethral slings, surgical procedures, operative, urinary incontinence, stress

Abstract

Background/Aim. Stress urinary incontinence (SUI) is the involuntary leakage of urine after increased in-traabdominal pressure, and it causes a significant public health problem by reducing the quality of life, causing sex-ual dysfunction, and increasing the cost of care due to in-creased morbidity. The aim of the study was to investigate the intra˗ and postoperative results and complication rates of the transobturator tape (TOT) procedures used for SUI treatments in a tertiary center located in central Turkey. Methods. This prospective study analyzed a total of 220 patients undergoing TOT procedures for SUI. The demo-graphic and clinical characteristics, preoperative and post-operative cystometry values, and operative outcome pa-rameters of the study participants were analyzed. Results. While no significant difference was noted between the preoperative and postoperative periods with respect to re-sidual volume (27.09 ± 8.51 mL vs. 26.01 ± 3.51 mL, p = 0.125), there were significant differences in terms of the first urinary urge (142.61 ± 20.25 mL vs. 145.64 ± 20.91 mL, p < 0.001), maximum bladder capacity (423.70 ± 38.43 mL vs. 402.32 ± 39.46 mL, p < 0.001), the Q-tip an-gle (45.54 ± 5.330 vs. 43.81 ± 6.150, p = 0.001), the maxi-mum flow rate (37.65 ± 11.54 mL/s vs. 24.38 ± 9.26 mL/s, p < 0.001), average flow rate (19.92 ± 9.64 mL/s vs. 14.77 ± 8.71 mL/s, p < 0.001), the number of urinations in the daytime (7.29 ± 1.35 vs. 6.58 ± 1.29, p < 0.001), and the number of urinations at nighttime (1.48 ± 1.01 vs. 0.92 ± 0.83, p < 0.001). Conclusion. The TOT procedure im-proves the quality of life of SUI patients and can reduce morbidity. Nevertheless, additional studies are needed to corroborate our findings and determine the long-term ef-fects.

References

1. Kaplan PB, Usta U, Inal HA, Tastekin E, Tokuc B. Neuromuscu-lar morphometry of the uterine ligaments and vaginal wall in women with pelvic organ prolapse. Neurourol Urodyn 2011; 30(1): 126‒32.

2. Abrams P, Andersson KE, Apostolidis A, Birder L, Bliss D, Brubaker L, et al. Members of the committees. 6th Interna-tional Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn 2018; 37(7): 2271‒2.

3. Inal HA, Kaplan PB, Usta U, Taştekin E, Aybatli A, Tokuc B. Neuromuscular morphometry of the vaginal wall in women with anterior vaginal wall prolapse. Neurourol Urodyn 2010; 29(3): 458‒63.

4. Santini S, Andersson G, Lamura G. Impact of incontinence on the quality of life of caregivers of older persons with inconti-nence: A qualitative study in four European countries. Arch Gerontol Geriatr 2016; 63: 92‒101.

5. Gibson W, Hunter KF, Camicioli R, Booth J, Skelton DA, Dumoulin C, et al. The association between lower urinary tract symptoms and falls: Forming a theoretical model for a research agenda. Neurourol Urodyn 2018; 37(1): 501‒9.

6. Inal ZO, Inal HA, Kucukkendirci H, Oruc AS. Investigation of cesarean sections at Konya Training and Research Hospital Obstetrics and Gynecology Department between 2010 and 2015. Ginekol Pol 2017; 88(4): 185‒90.

7. Matthews CA, Whitehead WE, Townsend MK, Grodstein F. Risk factors for urinary, fecal, or dual incontinence in the Nurses' Health Study. Obstet Gynecol 201; 122(3): 539‒45.

8. Minassian VA, Bazi T, Stewart WF. Clinical epidemiological insights into urinary incontinence. Int Urogynecol J 2017; 28(5): 687‒96.

9. Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Sou-za A, et al. Effectiveness of tension-free vaginal tape com-pared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol 2008; 112(6): 1253‒61.

10. Ulubay M, Fıratlıgil FB, Ozturk M, Kıncı MF, Fidan U. Periopera-tive outcomes of female stress urinary incontinence treated with transobturator tape. Cukurova Med J 2017; 42(4): 670‒4.

11. Malallah MA, Al-Shaiji TF. Pharmacological treatment of pure stress urinary incontinence: a narrative review. Int Urogynecol J 2015; 26(4): 477‒85.

12. Labrie J, Berghmans BL, Fischer K, Milani AL, van der Wijk I, Smalbraak DJ, et al. Surgery versus physiotherapy for stress urinary incontinence. N Engl J Med 2013; 369(12): 1124‒33.

13. Marshall WF, Marchetti AA, Krantz KE. The correction of stress incontinence by simple vesicourethral suspension. Surg Gyne-col Obstet 1949: 88(4): 509‒18.

14. Burch JC. Cooper's ligament urethrovesical suspension for stress incontinence. Nine years' experience-results, complica-tions, technique. Am J Obstet Gynecol 1968; 100(6): 764‒72.

15. Tanagho EA. Colpocystourethropexy. The way we do it. J Urol 1976; 116(6): 751‒3.

16. Walters MD, Karram MM. Sling procedures for stress urinary incontinence. In: Walters MD, Karram MM, editors. Uro-gynecology and Reconstructive Pelvic Surgery. 3rd ed. Phila-delphia, PA: Mosby Elsevier; 2007. p. 197.

17. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of fe-male urinary incontinence. Int Urogynecol J Pelvic Floor Dys-funct 1996; 7(2): 81‒5; discussion 85‒6.

18. Delorme E. La bandelette trans-obturatrice: unprocédé mini-invasif pour traiterl'incontinenceurinaired'effort de la femme [Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women]. Prog Urol 2001; 11(6): 1306‒13.

19. Aygül C, Özyurt R, Şık BA, Kumbasar S. Evaluation of the effi-cacy of transobturator tape surgery in the treatment of stress urinary incontinence using urodynamics and questionnaires. Turk J Obstet Gynecol 2016; 13(4): 172‒7.

20. Ulubay M, Ozturk M, Keskin U, Fidan U, Firatligil FB, Alanbay I, et al. Long Term Patient Satisfaction of Burch Colposuspen-sion with or Without Concomitant Total Abdominal Hysterec-tomy. J Clin Diagn Res 2015; 9(12): QC01‒3.

21. Inal ZO, Inal HA. Comparison of abdominal, vaginal, and lapa-roscopic hysterectomies in a tertiary care hospital in Turkey. Ir J Med Sci 2018; 187(2): 485‒91.

22. Magon N, Chopra SV. Transobturator Tape in Treatment of Stress Urinary Incontinence: It is Time for a New Gold Stand-ard. N Am J Med Sci 2012; 4(5): 226‒30.

23. Purnichescu V, Cheret-Benoist A, Eboué C, Von Theobald P. Surgical treatment for female stress urinary incontinence by transobturator tape (outside in). Study of 70 cases. J Gyne-col Obstet Biol Reprod (Paris) 2007; 36(5): 451‒8. (French)

24. Alagiakrishnan K, Valpreda M. Ultrasound bladder scanner pre-sents falsely elevated postvoid residual volumes. Can Fam Physician 2009; 55(2): 163‒4.

25. Wadie BS, El-Hefnawy AS. TVT versus TOT, 2-year prospec-tive randomized study. World J Urol 2013; 31(3): 645‒9.

26. Deval B, Ferchaux J, Berry R, Gambino S, Ciofu C, Rafii A, et al. Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence. Eur Urol 2006; 49(2): 373‒7.

27. Latthe PM, Foon R, Toozs-Hobson P. Transobturator and ret-ropubic tape procedures in stress urinary incontinence: a sys-tematic review and meta-analysis of effectiveness and compli-cations. BJOG 2007; 114(5): 522‒31.

28. Inal ZO, Inal HA, Gorkem U. Experience of Tubo-Ovarian Ab-scess: A Retrospective Clinical Analysis of 318 Patients in a Single Tertiary Center in Middle Turkey. Surg Infect (Larchmt) 2018; 19(1): 54‒60.